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Book Review: “No Time to Lose: A Life in Pursuit of Deadly Viruses” by Peter Piot; Reviewed by Jennifer Albertini, USAID Africa

Jennifer (Jenny) Albertini is Senior HIV/AIDS Technical Advisor for USAID Africa's Health Team where she focuses on policy, program and technical guidance for the Agency's HIV/AIDS programs in Africa. Jenny has worked with PEPFAR since its inception, including spending seven years in Zambia and Swaziland implementing and managing HIV/AIDS programs there.

Synopsis

For many, childhood is a time of wonder and ambitious dreams to travel to foreign lands and work on issues of social justice.

Often times, such dreams remain unfulfilled – but, not for Peter Piot. As he details in “No Time to Lose: A Life in Pursuit of Deadly Viruses,” more than half of Piot’s life has been spent chasing viruses and politicians around the globe in his effort to understand and mitigate the impact and devastation of infectious diseases.

What started as a mysterious virus delivered to his laboratory in Belgium in 1976 led to his first trip to Africa to pursue what later became known as Ebola. Before he knew it, Piot was partnering with scientists in Africa to investigate other infectious diseases, including sexually transmitted infections, positioning him well for when AIDS began chipping away at the continent in the early 1980’s. He was at the forefront of efforts to unravel what quickly became the newest and fastest growing pandemic. Translating his scientific prowess into bureaucratic-ease, a decade later, Piot helped bring together 10 United Nations agencies to form UNAIDS, the Joint United Nations Programme on HIV/AIDS. UNAIDS was the first UN agency dedicated solely to working on fighting one disease. He led the agency for 14 years (1994-2008).

No Time to Lose…” isn’t just about the laboratories and boardrooms that Piot was able to grace during his career. As he describes, his relationship with truck drivers and heads of state, physicians and patients, and commercial sex workers and advocates is what pushed him to keep fighting, learning, fundraising, and advocating for those affected with infectious diseases for more than thirty years. These relationships still drive him, and this book is as much a reflection of his career in global health as it is an expression of his respect for the people who have been most affected around the world.

Review

Piot’s book is not just a clinical review of infectious diseases – in fact, in the context of his narrative, Ebola or HIV & AIDS could have gone by any other name. What matters – and where Piot devotes much of his prose – is the impact that these diseases have had on the fabric of societies, and how the themes of poverty, family and governance radiate throughout all of their (and our) lives. He was able to connect the science uncovered in the laboratories with the faces of the patients he saw in clinics from Brussels to Kinshasa – and throughout the world. Perhaps most importantly, his book brings these stories to the world leaders he lobbied for so many years to do more to advance efforts to fight HIV & AIDS in their countries. He was not always successful at moving them towards action, but he always tried. And, his persistence is palpable through the pages.

I first saw Peter Piot in a nightclub in Rio during the International AIDS Society conference of 2005. As a self-proclaimed “public health nerd,” it was practically a celebrity sighting to see such an esteemed man dancing with the rest of us mere mortals. The results of a successful male circumcision trial in South Africa had been released that day and there was buzz in the air about this highly efficacious prevention intervention. It felt good to take a deep breath and celebrate a win for once.

One of my favorite quotes from Piot, as he describes AIDS, is, “This time, I knew, we were looking at the worst epidemic I could imagine, the greatest assailant I would ever face, something that would absorb all the energy that I could throw at it, and far more. In my mother tongue, Dutch, I wrote in my notebook:  Incredible. A catastrophe for Africa. This is what I want to work on. It will change everything.”

A lot of progress has been made since that catastrophe first started 30 years ago. We are now – hopefully – on a path towards creating an AIDS-free generation. As we commemorate World AIDS Day this year, a review of Piot’s book seems most timely. It allows us to reflect on where we have been and how far we have come, but it also serves as an impetus to keep moving towards our goal with a sense that there is ‘no time to lose.’

Discussion Questions

  1. Although Piot lobbied South African President Mbeki repeatedly to change his way of addressing HIV/AIDS in his country, years went by before real change happened as the epidemic grew worse. Was there anything Piot could have done differently to have moved Mbeki into action earlier?
  2. Certain African leaders (like Festus Mogae of Botswana) have been outspoken champions on HIV/AIDS. What are the characteristics or drivers which have made them positive leaders and what would it take for more of their peers to also take on these efforts?
  3. Did the creation of UNAIDS serve (one of) its intended purpose of focusing UN efforts around a single disease to achieve maximum impact, or would they have made more of an impact utilizing their existing platforms?
  4. Several recent articles have focused on balancing career and family, like Anne-Marie Slaughter’s piece “Why Women Still Can’t Have It all.” Piot mentions his family rarely in this book, although the birth of his children coincided with the beginning of the initial Ebola and AIDS outbreaks and he speaks volumes about his incessant travelling, late nights at work, etc. What are the differences that would have been experienced by a woman taking on Piot’s role at the time he worked on these issues?  What, if anything, would be different now?

Book Review: “Tinderbox” by Daniel Halperin & Craig Timberg; Reviewed by Roxana Rogers, Paul Mahanna, David Stanton, Office of HIV/AIDS

Roxana Rogers, Director of the Office of HIV/AIDS, has a lifetime of experience working for USAID, previously supporting health offices in Zimbabwe and Burkina Faso. She has also worked as the Health & PEPFAR Office Chief at the USAID mission in South Africa.

Synopsis

Daniel Halperin, a medical anthropologist with a peripatetic background, including work with USAID, and Craig Timberg, a Washington Post journalist, combined impressive talent in this book, which details the unintended consequences of colonialization as it created the ideal situation for an explosive AIDS epidemic.

For centuries, or even millennia, SIV (simian immunodeficiency virus) had been carried by monkeys, and probably jumped from monkey to man many times as men killed and cut up monkeys to eat as bush meat. But, until the time of colonial ransacking, the virus fell on wet moss, infecting households occasionally but travelling no further. The brutal intrusion of colonial Europeans seeking fast wealth and power destroyed ancient social norms, tore apart families and created a “tinderbox” ignited by the spark that turned into a raging epidemic.

The authors provocatively argue that Westerners, and even USAID, have failed to appreciate the unique risk factors in this tinderbox. HIV spreads in very different ways in different parts of the world, yet we used (and still tend to use) the same approach to fighting the epidemic everywhere. While acknowledging the importance of treatment and other interventions, the book argues that in Africa the major intervention for HIV should be prevention aimed directly at the main cause of its spread: sexual behavior. They also argue that local solutions work best.

Review

We found this a fascinating, very readable book that draws on science, social history, anthropology and personal stories to tell the evolution of the disease and recommend solutions.

The book traces HIV’s spread over the last century, starting from chimpanzees in isolated West African rainforests to the boomtown, Leopoldville, and from there to the rest of Africa and the world. It tells the unlikely story of how an American Rhodes scholar who had bicycled across Africa, paired up with a venerable evolutionary British biologist and traced the genetic history of the virus by analyzing samples of blood and tissues that had remarkably been preserved for 40 or 50 years. And, how Californian scientists studied monkey feces in remote sections of Cameroon to determine the exact area where the virus leaped from monkey to man.

It tells compelling stories about Africans infected early, before drugs were available, struggling to warn people to change behavior despite the stigma associated with AIDS; people like the famous Zairian singer Franco, who died in 1989; and, the popular Ugandan singer Philly Lutaaya who spent his last days singing messages of prevention and hope. And, how President Museveni in the earlier days of his presidency, recognized the threat posed by HIV and preached “zero grazing.”  Under the influence of this early leadership, behavior changed dramatically in Uganda and prevalence fell rapidly.

The authors also take aim with certain aspects of the U.S. Government’s President’s Emergency Plan for AIDS Relief (PEPFAR), which they say has taken an approach to fighting HIV that is expensive, not adapted or locally designed, and too dependent on technology. In its initial days, they say PEPFAR was too focused on A, for ‘abstinence’ when the focus should have been on B, for ‘be faithful’ – also known as partner reduction. They point out that condoms have a role to play where key populations – such as gay populations and sex workers – drive the epidemic, but not where the epidemic is generalized and affects all populations indiscriminately. USAID promoted condoms as one key strategy to fighting AIDS because they played a significant role in driving down the epidemic in the U.S., and because they were easy to count and report as indicators, claim the authors. Dr. Halperin, who was an outspoken advocate of circumcision to prevent HIV long before the World Health Organization (WHO) had endorsed it based on the outcome of three clinical trials, laments that had we promoted circumcision years earlier, much transmission would have been prevented.

Today, the United States is looking to eliminate AIDS as a disease of consequence. The tipping point, when the infection rate falls below the rate of new people on treatment, is in sight. In November, one year ago, Secretary of State Hillary Clinton announced that the U.S. Government is on the road to an AIDS-Free generation; then on World AIDS Day last year, President Obama announced that the United States, through PEFPAR, would scale up treatment, circumcision and prevention of mother to child transmission interventions, with the dual goal of saving lives and preventing new infections.

The contributions of the United States to fighting HIV & AIDS and improving health in Africa have been outstanding. Indeed, it is now hard to remember what Southern and Eastern Africa looked in 2003. AIDS affected every aspect of life. Hospitals were overwhelmed. I remember visiting a hospital where two people shared the same bed and a third laid on the floor. Coffin-making was a growing business and funerals were almost a daily event. This has turned around dramatically, with much credit to PEPFAR and USAID. Almost 8 million in the world are receiving treatment, and more than half of those receive some support from PEPFAR.

Indeed through PEPFAR, USAID has changed the world. Some coffin makers are going out of business. Yet, it would be a mistake to ignore the lessons from this book. We know that sustaining the response will be challenging over the long term. The findings of many studies confirm what we already know — that adherence is a challenge. Risk perception is low. Uganda, the early success story, is now experiencing an increase in prevalence as the commitment of local leadership has waned. Unless there is fundamental behavior change that accompanies the scaled up efforts around treatment, our remarkable success to date may be short lived.

Discussion Questions

  1. The authors present some unorthodox views on the long-term approaches to ending the AIDS epidemic. To what extent do you agree or disagree with their case for “how the world can finally overcome AIDS”?
  2. A number of countries are now experiencing declines in HIV prevalence. What, if any, are the roles of interventions that address changes in behavior as other more aggressive interventions, such as treatment for prevention and circumcision, are rapidly being scaled up in Africa?
  3. The AIDS epidemic in Africa is a tragic example of the negative consequences of both colonialization of Africa and the increased mobility and inequity that accompanied economic development. But, was it inevitable?  What are the lessons learned from the history of HIV in Africa and around the world?
  4. The book outlines the importance of local leadership in affecting social change. If this is true, what is the role of an international development agency in affecting sustainable long-term change?
  5. What most surprised you in the book?  Has your view of the HIV epidemic changed after reading this book and how?

Implementation Science in Action: Turning HIV Research Into an AIDS-free Reality

I began work in USAID’s Office of HIV/AIDS this past August – and, what an exciting time it’s been! With the agency-wide shift towards program efficiency, capacity building, country ownership and sustainability, a new term has risen to prominence: implementation science.

The implementation science framework aims to increase the sustainability, cost-effectiveness and impact of global health programs in areas hardest hit by HIV & AIDS. It translates and implements research findings into routine and common practice. As we come together this week to commemorate World AIDS Day 2012, it’s important to remember the vital role and impact implementation science has in helping us achieve an AIDS-free generation.

In August 2011, USAID announced the Annual Program Statement (APS), “Implementation Science Research to Support Programs under PEPFAR.” Under the first round of the APS, USAID and PEPFAR awarded more than $21 million for eight studies in eight countries. I’ve had the privilege to provide support to each of these eight studies. While implementation has only just begun, I am confident that the impact of these studies will be powerful.

These eight studies will answer critical questions such as:

  • How can we shorten the time between an HIV positive diagnosis and entry into care?
  • What are the most cost effective and feasible measures to significantly reduce MTCT?
  • How do we translate the high efficacy of antiretroviral-based prevention found in clinical trials to programmatic delivery?

Hopefully, by now, you are as excited about implementation science as I am, because this is your chance to channel your excitement into action! The second round of the APS “Implementation Science Research to Support Programs under PEPFAR” is underway. The APS solicitation is public and the deadline for concept paper submissions is January 31, 2013.  USAID anticipates awarding up to 10 awards, with maximum funding available for a single application set at $1.8 million over three years.

The scope of the APS provides a unique opportunity to fund cutting-edge research in HIV-specific program areas, improving the integration of programs across the prevention, care and treatment continuum.  Data gathered will support efforts to prevent new infections and save lives.

Have a great idea? Apply! Know a local organization with research capacity expertise? Share the solicitation!  I’m excited for the innovative ideas that will be evaluated in Round 2!

Young People in Bosnia Drive Economic and Social Development

The release of the new USAID policy (PDF) on youth and development is an opportunity to reflect on whether our work in development is truly serving the next generation.  As millions of young people transition from school to work, the urgency of the problem is clear. These young people have the potential to be engines of significant economic growth and agents of social change.  But if we fail to equip them with the skills they need, and if the market is unable to provide meaningful work, they will be a drain on national resources and a source of social instability.

Here in Bosnia and Herzegovina, the problems faced by youth are particularly severe.  Unemployment among young people between the ages of 15 and 24 ranges as high as 60 percent.  And young people in Bosnia and Herzegovina are suffering a crisis of confidence.  They have lost faith that this society can provide them any opportunity for success. Civic involvement among young people is extremely low, and an alarming 97 percent of youth believe they have no or little influence on important decisions in the local community.

But the problem does not lie in them.  The problem is a society where young people have been taught that corruption is normal and acceptable, that the powerful can prey on the weak with impunity, and that the citizen does not have a meaningful voice.

A young woman from Zvornik in north-east Bosnia-Herzegovina is using a blower door and meter to measure air leakages to determine weatherization strategies in a rural house for the upcoming winter.

Yet these young people are brimming with good ideas to challenge societal norms. With the help of USAID, young people around the country are developing projects and putting them in motion. These projects are designed to tackle many of the country’s greatest needs.  These young people want to be the driving force behind social change by rebuilding divided multi-ethnic communities, becoming political leaders, and working with local officials to push for changes and resources for youth-driven community projects. They are ready to move their country into a prosperous future as a member of the European Union.

Investing in these young people is one of the soundest investments we can make. Development programs targeting youth can be enormously cost effective.  USAID Bosnia is investing in programming that leverages three dollars for every dollar of USAID assistance.  We are investing in job training programs linked to strategic industries in partnership with the private sector.  And we are teaching young people how to advocate for themselves.  By strengthening civil society, promoting entrepreneurship and helping to develop young leaders, we believe that a small investment now will result in a significant return in both economic and social development.

For more about youth programs in Bosnia and Herzegovina, visit our website.

Shared Responsibility: The Catalyst for Long-Term Success in HIV & AIDS

Ariel Pablos-Mendez is the Assistant Administrator for Global Health

This post originally appeared on AIDS.gov.

This is a remarkable time to be in Global Health. The successes we are seeing now would not have been achieved without the shared responsibility and partnerships that have been forged over the years – most important of which are those with our implementing partners. Our implementing partners – in collaboration with civil society, the private sector, communities of faith, host governments, NGOs and many others local institutions – have been at the forefront of and catalyst for these shifts and transitions. And as we near World AIDS Day, we celebrate this collective effort as we get closer and closer to an AIDS-free generation.

But to make an AIDS-free generation a reality, we must continue to come together inclusively – understanding our strengths, contributions and the roles we each play in the response. This is about each player owning their part and sharing in the responsibility of reaching this goal– one that requires partnerships and long-term commitments, including collaborations with organizations like the Global Fund Against AIDS, TB & Malaria.

The U.S. is the largest contributor to the Global Fund, investing to date over $7 billion. USAID, through PEPFAR, works directly with the Global Fund by helping with grant oversight and implementation, managing the PEPFAR emergency commodity fund that works to respond to stock-out of drugs and other essential HIV & AIDS medicines and supplies, and working with Global Fund stakeholders to leverage resources in country. PEPFAR and the Global Fund are highly interdependent in supporting countries. Since 2011, the two have supported over 70 percent of all persons on treatment in developing countries worldwide.

Sharing responsibility through partnerships and inclusivity are particularly important for host nations as they move up the economic ladder. Many developing countries around the world are seeing unprecedented growth of their GDP, and half the low-income countries in 2000 will be middle income by 2020.  A growing number of our partner countries will reach total health spending levels per capita that enables them to cover basic health services for the first time in history.  This is a great success in international development and the tax-payers who make it possible deserve credit for this accomplishment.

This transformation is what I refer to as the ‘economic transition of health’. It is critical that efficient and equitable health systems be in place as this transition occurs. Otherwise, the poor may still not have access to quality services and others may be thrown back into poverty by catastrophic health expenditures. This could have significant negative effects on the work we do in HIV & AIDS and under PEPFAR. It could reverse many years of progress, and squash future gains for an AIDS-free generation, an end to preventable child death and maternal mortality. The time to create equitable and sustainable health systems is now.

Last week, I had the privilege of addressing over 42 of USAID’s PEPFAR implementing partner projects at our annual Partner’s Meeting. We talked about transitions in HIV & AIDS at the country level and the challenges and opportunities we face. The most purposeful transitions we are witnessing today is the shift from a U.S. Government to a country-led approach, from direct service delivery to technical assistance models, and from an emergency response to country-led and country-owned HIV & AIDS programs.

Countries want to step up, are proud of their HIV & AIDS programs and want results. Intensive conversations are being initiated and program reviews are being implemented, in particular around anti-retroviral treatment and preventing mother-to-child transmission. Tipping points are occurring in many countries, where the number of new HIV infections is lower than the number of deaths, marking the beginning of the end of AIDS. Shifts and transitions are happening at multiple levels and vary from country to country, and technical area to technical area, increasingly under the stewardship and growing financial support of national governments and local communities. Regardless of where a country or HIV & AIDS program is, our goal has been and will continue to be to move programs toward greater independence and sustainability.

We and our implementing partners have a tremendous opportunity to demonstrate our shared responsibility to making smart transitions and identifying strategic partnerships, while still meeting targets. It will require inclusive planning, growing local capacity and some patience. U.S. investments through PEPFAR have delivered extraordinary results. One year after President Obama announced aggressive targets, PEPFAR is on track to meet its goals. By working together at all these levels, we can foster functioning health systems with country ownership and sustainability, and reach our goal of an AIDS-free generation.

Learn more about our Global Health partnerships on Facebook and Twitter.

 

16 Day Challenge: U.S. and Afghan Governments Partner to Combat Human Trafficking

Today is Day 3 of our 16 Days of Activism Against Gender Violence.

USAID is highlighting the work of its Missions as part of its current campaign to raise widespread awareness about human trafficking and solicit innovative ideas to combat it at www.challengeslavery.org, where we launched a counter-trafficking Tech Contest today.

USAID is leading a U.S. government interagency process designed to help Afghanistan combat trafficking in persons. Through the Agency’s advisory efforts, the Afghan government has decided to establish its own steering committee tasked with addressing a crime that is becoming an increasingly significant problem in the country.  

According to the Department of State’s 2012 Trafficking in Persons Report, Afghanistan is a source, transit and destination country for men, women and children subjected to forced labor and sex trafficking. The majority of trafficking victims are children, and the International Organization for Migration reported in 2012 that younger boys and girls were increasingly subjected to forced labor in carpet-making factories and domestic servitude, and in commercial sexual exploitation, forced begging and transnational drug smuggling within Afghanistan as well as into Pakistan, Iran and Saudi Arabia.

Afghan children in Nuristan Province. Photo Credit: AFP Photo/Tauseef MUSTAFA

Some Afghan women and girls are subjected to forced prostitution and domestic servitude in Pakistan, Iran, and India, and there are reports of women and girls from the Philippines, Kyrgyzstan, Pakistan, Sri Lanka, Iran, Tajikistan, and China being forced into prostitution in Afghanistan. Labor recruiting agencies lure foreign workers to Afghanistan, and traffickers lure Afghan villagers to Afghan cities or to India or Pakistan, and then sometimes subject them to forced labor or forced prostitution after their arrival.

As part of the U.S. government’s commitment, the U.S. embassy in Afghanistan, led by senior diplomats from the Department of State and USAID, meet on a regular basis with their Afghan counterparts, including a meeting earlier this week in Kabul.

U.S. Ambassador Hugo Llorens and USAID representatives met with the deputy Minister of Justice and representatives from the Ministry of Foreign Affairs, Labor and Social Affairs, and Women’s Affairs.  The meeting focused on efforts to draft a National Action Plan, and how USAID and the embassy can assist in this important endeavor to help protect the rights of Afghanistan’s most vulnerable citizens.

During the meeting, Mohammed Ayoob Erfani, the Director General for International Affairs at the Ministry of Foreign Affairs, said the Afghan government is committed to progress in the area of combating trafficking in persons, and that he will commit resources to make sure that progress continues on this issue. The joint U.S.-Afghan efforts will focus on undertaking a national campaign designed to bring greater public awareness to this issue, and outreach efforts will be focused on educating civilians. 

Debra Messing, Actress and HIV Activist, Promotes HIV Combination Prevention in Zambia

This past May I traveled to Zambia and had the chance to see my taxpayer dollars hard at work – saving and improving lives.

I wanted to see, and learn, how “combination prevention” helps stop the spread of HIV. It’s actually pretty common sense stuff; when multiple interventions are used together, the likelihood of HIV transmission is greatly reduced.

One of my many honors in Zambia was launching a “New Start” counseling and testing center, funded by the U.S. government, with USAID Zambia Mission Director, Dr. Susan Brems, and representatives from the Zambian Ministry of Health.

Debra Messing, Actress and PSI Global Health Ambassador, cuts the ribbon at a US-funded New Start HIV counseling and testing center in Mongu, Zambia. Photo Credit: Zoeann Murphy

The New Start center is located in Mongu, a small, isolated town in Western Province. I was amazed to learn that this was the first center in the area that offered services like voluntary counseling and testing for HIV, male circumcision, STI diagnosis and reproductive health services — all under one roof.

There were nearly 200 people who came from all over the community to be at the launch event. It was a hot muggy day, but still, there were lots of singing and dancing and drama. It was truly a celebration.

Now, the New Start network has nine centers in seven provinces—and reaches more than 14,000 Zambians each month with much needed HIV services. This is incredible to me.

After I cut the ribbon at the New Start center, I had a chance to meet the counselors and nurses who will actually be providing HIV counseling and testing services to the community, and they absolutely beamed with pride. They were excited to walk me through each of the rooms in the clinic—only five in all. I could tell they really wanted me to see and understand what this clinic means to the people in their community.

Seeing their enthusiasm made me so proud to know that the Zambian Government and my government are working in partnership through USAID and PEPFAR, with local organizations like Society for Family Health (SFH), as well as private sector partners— so that residents of Western Province have access to the health services they need.

I now realize that if we are really going to see an AIDS-free generation, we have to work together.  It takes partnerships at all levels – from governments to grassroots to the private sector. Everyone has a role to play.

In Celebration of Men: Stepping up for Male Circumcision

Emmanuel Njeuhmeli serves as Senior Biomedical Prevention Advisor at the Office of HIV/AIDS.

On November 19, the first ever International Men’s Day was celebrated in over 60 countries around the world. It was an occasion to put the spotlight on men’s health, improving gender relations, and recognize positive male role models who make valuable contributions to family, community and society. This year, we recognize and celebrate the hundreds of thousands of men in East and Southern Africa who are stepping up for Voluntary Medical Male Circumcision (VMMC) to protect their own health and that of their families.

We also recognize the political, traditional and community leaders who are leading the charge in their countries and local communities. For many communities, male circumcision has cultural significance representing a rite of passage from childhood to manhood. Ministries of Health are working closely with traditional leaders to ensure that male circumcision is medically safe while still respecting the meaning of the tradition. In 2011, I participated in one such ceremony with the Changaani tribe at an “initiation camp” in a remote area of southern Zimbabwe where adolescent boys learn what it means to be a man. Despite the cultural challenges, the Zimbabwe Ministry of Health and Social Welfare (MOHSW) with support from PEPFAR and USAID, and in collaboration with traditional leaders, was able to provide these boys with safe male circumcision services.

In June 2012, I was again fortunate to witness the kind of male leadership we celebrated on Nov. 19. Mr. Blessing Chebundo, Chairman of Zimbabwe Parliamentarians against AIDS, and a group of fellow Zimbabwe parliamentarians, underwent voluntary medical male circumcision to inspire other men in their country to follow suit. Zimbabwe aims to circumcise 1.2 million men aged 13 to 29 years by 2015 with the potential impact of preventing 750,000 new HIV infections.  It will take leading by example, as demonstrated by Mr. Chebundo, to get this done.

USAID and UNAIDS have estimated that VMMC has the potential to avert more than 3.4 million new HIV infections in 14 countries in Eastern and Southern Africa, and save an estimated $16.5 billion in care and treatment over the next  15 years, freeing up resources for other crucial HIV interventions. It also offers a unique opportunity to not only prevent HIV, but improve men’s overall health. VMMC services present an opportunity to engage men who might otherwise never interact with the health system.

While women are likely to learn their HIV status during prenatal visits, there are simply no comparable programs for reaching men. VMMC programs have the potential to offer millions of men the opportunity to learn their HIV status, along with counseling, condom provision, services around sexually transmitted infections, and the rare chance to discuss their reproductive health.

USAID, with PEPFAR funding, is committed to supporting countries in Eastern and Southern Africa to pave the path for an HIV-Free generation by accelerating scale up of VMMC over the next five years. As we work together to roll out this powerful, life-saving intervention in these 14 countries, let us remember the more than 2 million men who have already made the brave decision to step up and protect their health, their family and their communities by getting circumcised.

I wish all of you brave men a very happy International Men’s Day!

Video of the Week: Improving Property Rights One Mine at a Time

What started as a small pilot project in the remote mining regions of the Central African Republic (CAR) is now influencing the highest levels of government and has the potential to affect historic legal reforms that will improve land and property rights for land holders and miners throughout the region.

There are many drivers of conflict in CAR, including a lack of secure land rights for small-scale diamond mining. Mining is a sought employment because it is a good source of income, and having control over a mine means a better social and economic status. But, when the rights over mines are unclear, disputes often arise between individuals competing for access to the same piece of land.

In August 2012, the Government of CAR decided to amend its property laws with support from USAID’s Property Rights and Artisanal Diamond Development (PRADD) program. At the center of PRADD is an effort to clarify and strengthen the property rights of artisanal miners. The program was recently recognized by the Prime Minister and the Cabinet in CAR as an important source of technical authority on property rights. PRADD focuses on the mining sector, but the positive impact of the project is also driving changes in property laws that apply to land, trees and water. USAID is engaged in the reform process and is participating in a committee tasked with drafting a single land tenure code that takes into account the Voluntary Guidelines on the Responsible Governance of Tenure adopted by the Committee on World Food Security in May 2012. Negotiations  for law reform will begin in late 2012 or early 2013.

The origins of the PRADD program go back to 2003, when the Kimberley Process Certification Scheme (KPCS) was established to stop trade in “conflict diamonds,” and ensure that diamond purchases were not financing violence by rebel movements and their allies seeking to undermine legitimate governments. In 2007, in support of the U.S. Clean Diamond Trade Act (PDF), USAID initiated PRADD in CAR to support the KPCS, and started tracking and monitoring diamond sales. Immediately, the program improved the livelihoods of artisanal diamond mining communities.

Since its inception, the project has mapped 3,896 mining sites with GPS coordinates, and worked with the CAR government to publicly validate and issue property rights certificates to 2,849 mining households. The certificates, signed by the Ministry of Mines and delivered through PRADD, are not recognized under CAR’s current legal framework, but they are widely recognized as contributing to decreases in property conflict and increases in local investment. The hope is that with the government’s decision to amend its property laws, this legal gap may close completely, and the communities in CAR will have government support for basic  land ownership rights.

For more information on artisanal diamond mining and PRADD, watch the videos below (also available on USAID’s YouTube channel).

Leading the Way in Enterprise Development

Eric Postel is the Assistant Administrator for Economic Growth, Education and Environment.

Small Business Saturday, a day dedicated to supporting U.S. small businesses, is a great opportunity to highlight the importance of women-owned and managed small businesses around the world. According to the Center for Women’s Business Research, women-owned businesses in the United States contribute nearly $3 trillion to the economy annually, and have been growing at more than twice the rate of businesses owned by men. According to the International Financial Corporation, in emerging markets, women own or co-own about one-third of formal small and medium enterprises (SMEs), but most of these tend to be smaller than men-owned businesses.

At USAID, we are committed to supporting women’s entrepreneurship in developing countries, where it can raise incomes while reducing poverty and inequality, for the women, their families, their employees, and their employees’ families. Women tend to spend more of their earned income than men on the health and education of their families. National economies can’t afford to waste the talents of half the population.

Acknowledging this, USAID recently launched the Women’s Leadership in Small and Medium Enterprises (WLSME) initiative in partnership with the World Bank, and the non-governmental organizations ACDI/VOCA, CARE, and Grupo de Análisis para el Desarrollo (GRADE). The aim of USAID’s $8.5-million investment in these and related partnerships is to find innovative ways to remove some of the barriers to women owning and managing small and medium enterprises.

Svetkul Akmatova (center, in the traditional blue Kyrgyz jacket) and members of her organization, Altyn Kol Women's Handicraft Cooperative, busily prepare wool for their handmade carpets. Photo Credit: B. Jakypova, American Council for International Education

What are some of these barriers that stop women in the developing world from getting beyond a one-woman enterprise? They include: access to finance; legal and regulatory constraints; cultural practices; and women’s tolerance for risk in managing their businesses. Two important constraints that WLSME will focus on are: women’s access to and role in business information and knowledge networks; and women’s business and technical skills, education and experience.

ACDI/VOCA will use technical assistance and support for business associations to improve women’s access to larger loans in Kyrgyzstan. CARE will support the growth of women’s enterprises within the cashew value chain in India through training, networking and building family support. GRADE will compare the effectiveness of mentoring and peer networks for women looking to grow their businesses into SMEs.

In keeping with USAID’s learning agenda, these partnerships will be evaluated to tell us what worked and why, helping to improve future efforts to place women in leadership roles in enterprise development, economic growth and poverty reduction around the world.

Visit WLSME‘s website to learn more about the initiative, our partnerships in India, Kyrgyzstan and Peru, or to share your organization’s lessons learned.

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